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~ <br /> FOR ~'' '^^ USE: - <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit No. <br /> This ^ Doh» Issued <br /> Permit Expires 1 Year From Date Issued <br /> -- . - - ` � <br /> tn the' <br /> Sun Jooqv|n Luco| Health District for o 'permit ��cnnxo�c �n6 'install the work herein <br /> described. This application is made No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION . -cr-. _// ��------------ ------- --------------------------CENSUS TRACT ------------------- <br /> Owner's Name_ m .. ^ ' ------ Phone <br /> Address ---�-�. y--------.--- Cn <br /> Co . � -l|censn .- Pk.�p-^ne <br /> nt actor's Name <br /> Installation will serve: Residence W1Apartment Hooue,E] Commercial E]Tnu|lnrCourt 0 <br /> � <br /> Mote []Other --- ------._'_ <br /> � <br /> Num6n, of Uving vnhn`� -. Number of 6o6rpon,u - �Z .���-.� �� �i � .x �� ._-' <br /> . - ---' - <br /> VVoter Supply: Public System and name ------_'—� _----__'_'' Private 0 ' <br /> � ~--� ----'__.---- <br /> Character ofsoil toodepth.of'Veet: -Sand []- SiltE-1Clay El Peat E] Sandy Loam ,[] Clay Loam F-.1 ' <br /> Hardpan E] Adobe 1K RU Material ---- If yes, type ----------NEW INSTALLATION: 1--.- <br /> (Plot plan, showing size of Gt,. location of system in relation to- wells, buildings, etc. must be placed 'on reverse side.) <br /> (No 'e/'- _tank - _-pagq pit-Permitted. . . public sewer ." available within 2owrex'/ v~ <br /> PACKAGE TREATMENT [ ] SEPT|CTANKf ] � . Size------------------------------------------------ Liquid Depth 6% <br /> . ~- <br /> . <br /> Capacity ------ Type -- �`---.. ---------- No Compartments --.----'.-' ~~ <br /> . ' ` <br /> ` <br /> Distance to nearest- VV��------------ <br /> --. --.--.-__.Foun6otiun -------. Prop Line --'_---_ <br /> LEACH|NG LINE Do No ' Lines -------- ---------- -- Le`6fh of each line------ � ''-'Toto .. Ze� .�------------- <br /> 'D' <br /> _''''Cr Dox -.� v/ Typ* Filter kAaiedo - --'Deoth Filter Material <br /> � . - --.-'/�^. --------------------- <br /> Distance <br /> ^v--''~--_- <br /> -_- <br /> D.°.",x= hz noon*m. Well =�r �� . F�un�o,k»n ~�-0- /.-' � <br /> Property Line ----- <br /> SEEPAGE PIT �� Dooth \---42--of--- Diameter Number --..,�-----. Rock Filled Yes.[� . <br /> VVoter'To6|e Depth -----«��^�..� �. ----------Rock Size -.. 2r..^ '._---. <br /> � I ` ' l <br /> ,^ -^ ~ <br /> . <br /> Distance to naoms+ Well -----------77-7�-------------Foundation -- Prop. Line ----- � <br /> RE (Prev ScinitoHon Permit# _----._-----..^-1Qate —_.—.---'----J <br /> 5eptic Tank (Specify Requirements) ------------.-----._---_._---_._--__---__--_-- -- <br /> ' ^ <br /> Disposal Field (Specify Requirements) ---------------^��� - <br /> ^�m � ~ <br /> -------^��'~^..'^.~�'.,_�.^r^��..-'________-------------------------------------------------------------------------------------------------------------- <br /> ' <br /> --- ---- -------------- ---------------------------- '_—_-'-- - <br /> ---_--.. ----.—_-_'-_----.'+—_------_'- <br /> (Draw e��Ung and required addition on reverse side) <br /> ' <br /> | he�6 certifyH`o� X haveprepared this ����m�n mn6 ��w� �w work will be done in accordance� with Som <br /> lri <br /> County Ordinances, �wm*e L�vvn mm� ��yen �m� �m��HmHwo« o£�6w^�S�n Jwm�wXm &pm�Y �mm|�� �|w��*� Home wwwne, m* licen- <br /> sed ' ' <br /> agents signature me�|�es�HefmlymwWmg: ~ ' � <br /> `^| certify that in the perform a`_&'"f the work for which MW-Oemn|t is issued,'�'shmY| not employ any person in such mmmmmr <br /> as mmbecome subject h* Workman's Com `mmywtimn Uaxvm of Co' 8fwrnia"'', � <br /> 8|8ne6 ----------------------------------- <br /> ----------.-'- � (]vvner� <br /> �--- - ° <br /> »P =�. ------�-... T�e - ~ <br /> (|f other than ovvner — ~=-------- <br /> � <br /> FOR DEPARTMENT USE ONLY <br /> ADDITIONAL COMMENTS -- -- - ---'--'r'---'-- --'---'--~'^'^ - - ------ ^ <br /> -_---.---'_--.-'-__'--.-- - ----.----'—_--_-_-_^-._.--'—. <br /> --.---_~_- - - .-^--~-..^-.--~- - - - - '-_-_-..^--------- - - - - - - - - - - - - - - - -- <br /> ---,- - - - - - - <br /> -_---_--.—. '—.-----'—.---.----''- <br /> ���- _� - - �' <br /> �no| |nmpec�on6y '/ - - - - - <br /> -------'-- -- - --'- <br /> ' --7'— '-�� -- - - -- - - - -Cate <br /> ^�| J ^- / � ^ <br /> ��m �A�U|�0 LOCAL HEALTH ��TR|CT <br /> ��,� ~ <br /> -- <br /> (ns�r <br /> E H. 9 1''68 Rev. 5kk ~-° ! <br />